Thromboelastography and Thromboelastometry in Assessment ...
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The Use of Thromboelastography for Assessment of Coagulopathy in Non-trauma Critically Ill Patients.
Presenter :
Samid M Farooqui M.D
PGY2, Department of Internal Medicine
Oklahoma University of Health Sciences Center
Disclosure Statement
• I, Samid M Farooqui, have no financial disclosures that would be a potential
conflict of interest with this presentation.
Background
• TEG provides a graphical representation of the viscoelastic changes that occur
during the fibrin polymerization process1.
• It evaluates the whole mechanics of clot formation and provides a better
understanding about the interaction between plasma components and cellular
components during clot formation.
• TEG gives a functionally relevant insight into the coagulation status of critically ill
patients.
• TEG scans are used to guide transfusion in trauma patients and multiple studies
have been done to validate it’s use in trauma patients2,3
• Tartamella F et al.4 reported Thrombodynamic ratio to be an independent
predictor of the odds of thrombosis in critically ill patients.
Objective
• To determine the utility of TEG scans in the assessment of coagulopathy and risk
of bleeding in non-trauma, critically ill patients. .
METHODOLOGY
• Critically-ill patients admitted to the medical ICU with abnormalities in standard
coagulation panel.
• Comparison between patients with normal vs. abnormal TEG panel.
• Retrospective cohort analysis.
• Primary outcome: Development of a bleeding-related event (composite of major
bleed, drop in hemoglobin or need for PRBCs transfusion)
• Inclusion Criteria
Critically Ill adult patients with an abnormal DIC panel.
• Exclusion Criteria
Patients bleeding on admission
Patients receiving anti-coagulation on admission
Patients who received blood products before TEG scan analysis.
RESULTS
Relative risk = 2.15 (CI 1.0-4.62)
p = 0.0377
RR = 1.07
p = 0.6733
RR = 1.88
p = 0.17
RR = 2.69
p = 0.0157
DISCUSSION
• Abnormal TEG cohort had a higher incidence of bleeding-related events.
• A significantly higher number of patients in the abnormal TEG cohort required
transfusion of PRBCs.
• There seems to be a trend towards a higher need of blood products in the
abnormal TEG cohort.
CONCLUSION
• There is a difference between the incidence of clinically significant bleed and TEG
(normal or abnormal).
• Patients with abnormal TEGs require more PRBC transfusions than those with
normal TEGs.
• Lloyd-Donald et al 5 compared TEG scans in acutely ill Chronic Liver Disease
patients with TEG scans from normal patients and concluded that there was
“delayed clot formation and weaker thrombus strength despite decreased clot
lysis”.
LIMITATIONS
• Single center
• Retrospective data
• Small sample size
Future directions
• Prospective analysis
• Data in patients with chronic liver disease
Acknowledgements
• Dr. Roberto J. Bernardo
• Dr. Ahmed A. Awab
References
1. R.J.Luddington, Thromboelastography/thromboelastometry. Clin. Lab. Haem 2005, 27,
81-90.
2. Cotton BA et al. Rapid thrombelastography delivers real-time results that predict
transfusion within 1 hour of admission. J Trauma 2011 Aug;71(2):407-14.
3. Holcomb et al. Admission rapid thrombelastography can replace conventional
coagulation tests in the emergency department: experience with 1974
consecutive trauma patients. Ann Surg 2012 Sep;256(3):476-86.
4. Tartamella F, Vasallo MC, Berlot G, Grassi P, Testa F. Thromboelastographic predictors
of venous thromboembolic events in critically ill patients: are we missing something?
Blood Coagul Fibrinolysis. 2016 Oct;27(7):804-811.
5. Lloyd-Donald P et al. Coagulation in acutely ill patients with severe chronic liver disease:
Insights from thromboelastography. J Crit Care. 2017 Apr;38:215-224.